The relationship between alternative assessments of self-care ability in the elderly

Resilience and caregiving ability among caregivers of people with stroke: The mediating role of uncertainty in illness

BACKGROUND

In China, stroke survivors are usually cared for by their family members. However, the caregiving ability of these informal caregivers remain inadequate during the hospitalization of their family members following a sudden onset of a stroke, and this sudden need for care overwhelms caregivers even after the hospital discharge. Therefore, research is required to identify predictors of caregiving ability that could be targeted in future interventions aimed at improving caregiving skills and reducing the burden on caregivers who care for stroke survivors.

MATERIALS AND METHODS

From August 2019 to February 2020, stroke survivors were hospitalized for the first time, and their family caregivers were registered via convenience sampling. Caregiver demographic information, resilience status, uncertainty in illness, caregiving ability, and patients' severity of stroke were measured using standardized questionnaires. Structural equation modeling was used to test the proposed model, where caregiver resilience and stroke severity predicted caregiving ability directly, and uncertainty in illness mediated the association between caregiver resilience and caregiving ability.

RESULTS

A total of 306 dyads were included in the study. The tested model fit the data well (χ² = 118.2, df = 64, RMSEA = 0.053, CFI = 0.946, TLI = 0.923). Statistically significant pathways linked caregivers' resilience status to uncertainty in illness (β = -0.558, S.E. = 0.022, P < 0.01), caregivers' resilience to the status of caregiving ability (β = -0.269, S.E. = 0.013, P < 0.01) and caregivers' uncertainty about the illness to caregiving ability (β = 0.687, S.E. = 0.051, P < 0.01). We also found that caregivers' uncertainty in illness mediated the association between caregivers' resilience and caregiving ability (β = -0.384, S.E. = 0.061, P < 0.01).

CONCLUSIONS

Our structural equation modeling result identified resilience and uncertainty about the illness as predictors of the caregiving ability of informal family caregivers who suffered from care burdens. Supporting family caregivers to build their resilience and reduce illness uncertainty may improve caregiving for stroke survivors.

Mental status and occupational therapy outcome in teaching dressing skills to the disabled elderly

Two groups of elderly disabled patients referred to an occupational therapy (OT) department, one of higher and one of impaired cognitive status, defined by the mini-mental state examination (MMS), were assessed before and after one month's OT to see if mental status predicted improvement in dressing skills. The Kuriansky Activities of Daily Living performance test (KPT), the Set test (ST) and a specially designed dressing skills task (DST) were administered before and after treatment. Cognitive status as measured by the MMS and the ST were related to the global measure of activities of daily living (KPT) before treatment but not to the specific dressing skills task.

There was no significant relationship between cognitive status and OT outcome either in terms of dressing, KPT performance or discharge. The therapist's prediction of outcome at the initial assessment was accurate. A subsidiary study found that all patients entering the hospital over a six week period, likely to benefit from OT were in fact referred.

Self-Report of Functional Abilities in Older Adults With Mental Retardation: ADLs and IADLs

The purpose of this study was to examine the validity and reliability of self-report in determining functional abilities in older adults with mental retardation. Thirty participants were interviewed twice using the index of Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL) scale, which were modified to include structured probes. The participants' self-reports were compared to informant reports from their care providers. Significant test-retest reliability and a significant correlation between participants' self-reports and informant reports were found. Reliability and validity of the index of ADL were increased by eliminating the item on incontinence. Analysis of the data confirmed the hypothesis that the modified ADL and IADL instruments could be used to obtain reliable and valid self-report data regarding functional ability in older adults with mental retardation. This information is useful to professionals in the generic aging service system who are now serving persons with mental retardation.

The Reliability and Validity of Self-Report Activities of Daily Living Scales

A measurement evaluation study was conducted to examine the reliability and validity of the Physical Self-Maintenance Scale and Instrumental Activities of Daily Living Scale (Lawton & Brody, 1969) as a discriminative measure to assess the independent living status of elderly hospitalized patients. A sample of thirty patients from two geriatric specialty units was used for the study. Inter-observer reliability was shown to be excellent (ADL r=.96, IADL r=.99) and test-retest reliability was considered to be good (ADL r=.59, IADL r=.93). The results comparing patient self-report of ability and ratings based on direct observation of performance indicated that patients consistently over-rated their ability in both ADL and IADL tasks. This provides support for the use of direct observation of performance to obtain valid data on an individual's ability. There was a significant difference in scores between those patients able to be discharged home compared to those requiring institutionalization; however, a score predictive of discharge location could not be identified with the study data. The study provided support for the use of this measurement tool for assessing the independent living status of elderly hospitalized patients. It provides the therapist with a measure that has had some validation and has the potential for clinical use in describing patients' ability and identifying areas requiring treatment intervention.

The Use of “Risk” in Decision-making

Cet article discute des limites auxquelles il faut faire face quand la notion de risque devient le facteur-clé dans une évaluation clinique. Ainsi, on présente la capacité de se choisir une place en centre d'accueil, pour illustrer la façon dont le problème est défini. En l'absence de composante évaluative, il est démontré que l'information habituellement recueillie ne peut être utilisée pour évaluer les risques sans y inclure un élément normatif. Une discussion concernant la nature du risque montre que les orientations normatives sont inhérentes à la perception du risque. Les principaux inconvénients, de permettre que les résultats soient étroitement rattachés à la notion de risque, sont de deux ordres: (1) les probabilités des risques ne sont pas connues et (2) les enjeux, chargés de valeurs, demeurent inconnus.

Disability in dementia: assessment, prevention, and rehabilitation

Dementia involves cognitive impairment sufficient to interfere with daily living. Most cases of dementia are due to Alzheimer's disease or cerebrovascular disease. Surveys show that dementia is one of the major causes of disability in the elderly, affecting personal care, everyday cognitive activities, and social behaviour. Several instruments relying on informant reports or behavioural observation have been developed to assess these various components of disability in dementia. Prevention of dementia would make a major contribution to the postponement of disability in old age. In principle, this could be achieved by modifying risk factors for Alzheimer's disease or vascular dementia. There is presently scope for the prevention of vascular dementia, but risk factors for Alzheimer's disease are not sufficiently understood. The paper discusses how, where dementia has already developed, programmes involving cognitive training or environmental redesign can help to maintain skills and reduce behavioural disturbances.

The accuracy of self and informant ratings of physical functional capacity in the elderly

To compare the accuracy of self-ratings with informant-ratings of physical functional capacity in the elderly, 150 elderly patients attending a geriatric day hospital (GDH) and their formal and informal community carers were administered a questionnaire about their ability to perform activities of daily living (ADL). Direct observation of the patients' performance by therapists at the GDH was used as a standard, after the reliability and validity of this approach had been evaluated. Self-ratings were shown to be more accurate and less biased than informant-ratings, both for individual ADL and overall functional capacity. The accuracy of all ratings tended to be greater for less complex or physically demanding ADL, and informants tended to consistently underestimate functional capacity. The concurrent validity of the adapted Barthel Index in a self-report format was also demonstrated. Wherever possible, information concerning the physical functional capacity of an elderly subject should in the first instance be sought from the subject himself, as the quality of such information may be superior to that of his carers.

Self-care and the elderly: review and implications

Self-care is the most predominant and basic form of primary care, yet research in the area, particularly with respect to the elderly, has been minimal. As a result, despite the breadth of the self-care movement, very little is precisely known and understood about it. Diminished functional health status is the major cause of loss of independence. Self-care is conceptualized as an important strategy in maintaining functional health.

The heterogeneity of social outcome following head injury

This study compares nine different measures of social outcome applied to 56 patients seen 0 to 4 years after head injury. Social outcome was found to be heterogeneous: correlations between the measures and a principal components analysis both indicated that time off work (as a percentage of time since injury) was independent of most other measures of social performance. In the group studied, the best measures of non-work social performance were the Katz Adjustment Scales form 2 (socially expected activity) and Bond's Social Scale, which both showed good agreement between subject and informant ratings. If a single outcome measure is desired (to include work and non-work social performance), the most suitable measure was found to be the Glasgow Outcome Scale, original and extended versions.